Introduction: Clival chordomas confront the surgeon with the task to remove an aggressively invasive and de- structive tumour in a critical surrounding.
Methods and results: In this paper, we describe the concept of tailored endoscopic transnasal removal of large clival chordomas, operated in the skull base units in Zurich, Budapest and Debrecen. Central lo- cated tumors of the clivus were treated via a mononos- tril transethmoidal paraseptal approach. Transnasally, only inferior and lateral located lesions infiltrating the petrous bone were approached via a binostril route. Extended lesions were treated via combined transna- sal / transcranial approaches for maximum possible tumor resection. Mucosal destruction was minimized, nasoseptal flap was used only by wide dural opening. The middle and inferior turbinates could be saved in all cases.
Conclusion: Individually tailored minimally invasive endoscopic transnasal approaches via mononostril, binos- til or even via a combined route offer a feasible surgical access for large clival chordomas. In our opinion, radical resection can be achieved while minimal approach-relat- ed trauma of the nasal cavitiy.